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Quick Tip for Families in Intensive Care: My Dad Didn’t Need the Tracheostomy & is Now Off the Ventilator! Should We Do a PEG (Percutaneous Endoscopic Gastrostomy) or NG (Nasogastric) Tube for Feeding?

“My dad didn’t need a tracheostomy, and he’s now off the ventilator and the breathing tube. Should we still do a PEG (Percutaneous Endoscopic Gastrostomy) or nasogastric tube for feeding?”

My name is Patrik Hutzel from intensivecarehotline.com with another quick tip and update for families in intensive care, where we answer critical questions for families in intensive care that come up for many families in intensive care, especially when a loved one is coming off the ventilator.

So, here’s the situation. Theresa says, “Thank you for your perspective on the tracheostomy.” This is one of our members that we’ve been working with for quite some time.

You can join our membership at intensivecarehotline.com if you want to become a member and help families in intensive care.

This client initially came to us and asked whether her dad should have a tracheostomy or whether there was a chance to be weaned off the ventilator and avoid the tracheostomy. We said there is a chance to wean off the ventilator and avoid the tracheostomy, and that’s exactly what came true.

So then, the member says, “Thank you for your perspective on the tracheostomy. Thankfully, we didn’t do the tracheostomy and my father was able to wean off the breathing tube on Friday, and he has been stable since. He’s swallowing okay and he’s managing his secretions. He didn’t fully pass the swallow tests today. He did okay with water and honey consistency, but not apple sauce. We are trying again tomorrow.

What is your suggestion/opinion regarding putting a tube in for feeding or hydration until he can manage to eat okay on his own?”

So, here’s the situation. It’s great that your dad made it so far. Your dad has successfully avoided the tracheostomy. He’s been extubated and he’s stable off the ventilator, so you’ve done really well there because if you had listened to the ICU team, they would have just done a tracheostomy, and they would have sent him to an LTAC (Long Term Acute Care). This is a client in the US obviously.

He’s swallowing some, handling secretions, managing thin liquids and honey consistency during the swallow test. He didn’t pass with apple sauce today, but another attempt is coming tomorrow. Now you’re being asked, should we put a feeding tube in, maybe a PEG tube (percutaneous endoscopic gastrostomy) or a nasogastric tube, and the clock is ticking.

Here’s what you need to know based on my experience helping families in intensive care for 25 years. I’ve worked as a critical care nurse in intensive care for over 25 years in three different countries.

So, number 1, you did the right thing, not rushing the tracheostomy. That’s well done to you, first off. The system often pushes for the tracheostomy too early; you waited, your dad got through it, and now he’s breathing on his own. That’s a major win.

Number 2, feeding tubes, PEG versus nasogastric tube, what’s the real deal? Right now, your dad’s swallowing isn’t quite back to full function, and that’s completely normal after extubation, especially in elderly patients or after prolonged intubation. If he does need nutritional support short term, a NG tube or a nasogastric tube is the way to go. It’s less invasive, it’s quick to place and can be removed easily once he’s eating again. There’s no need for a PEG unless your dad shows no signs of swallowing, recovery after several weeks, which doesn’t sound is the case.

Number 3, avoid the PEG unless absolutely necessary. A PEG is a surgical procedure. Once it’s done, doctors often get lazy and stop trying to wean off it. It’s meant for long-term feeding, usually when there’s no recovery inside, but your dad is already halfway there. He’s swallowing water, thick fluids. Give it time. Push for daily speech therapy and swallow rehab. Let the body catch up.

Number 4, do not let the hospital rush you. Hospitals often want a PEG to discharge someone faster, either to rehab or nursing home. Don’t fall into that trap. Ask, “Can we keep the nasogastric tube a little longer while he’s recovering?” Make sure they’re giving enough time for swallow therapy, nutrition, and hydration before making irreversible decisions.

Final thoughts. Stick with the nasogastric tube for now. Monitor progress daily and re-evaluate in 5 to 7 days. If he’s showing improvement, and it sounds like he is, there’s absolutely no need for a PEG tube. Keep advocating for your dad’s progress the way you did with the ventilator and tracheostomy because it’s working. You’ve got this, and if you need help to further negotiate with the hospital and with the ICU or making the right next move, reach out. This is exactly what we help families with here every day at intensivecarehotline.com

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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